O-39 : Initial Experience of High-Volume Plasma Exchange In Patients with Acute Liver Failure

Aims: High-volume plasma exchange (HVP) defined as exchange of 8-12 or 15% of ideal body weight with fresh frozen plasma has shown promising results in improving survival of patients with acute liver failure (ALF). However, real-life clinical evidences are still limited. The aim of this study was to report our initial experience of using HVP as a bridge treatment in patients with ALF. Methods: We retrospectively reviewed 32 consecutive patients who were enlisted for liver transplantation (LT) due to ALF between 2013 and 2020 at Samsung Medical Center in Korea. HVP was initiated in patients with ALF since May 2016 at our institution. Results: During study period, 16 Patients received HVP. After HVP, coagulopathy (prothrombin time, INR, 4.46 [2.32-6.02] vs. 1.48 [1.33-1.76], P<0.05), total bilirubin (22.6 [9.1-26.4] vs. 8.9 [5.6-11.3], P<0.05), ALT (506 [341-1963] vs. 120 [88- 315], P<0.05), and ammonia level (130.6 [123.7-143.8] vs 98.2 [84.2-116.5], P=0.033) were improved. Improvement in hepatic encephalopathy grade was observed in four patients, including three case of spontaneous recovery. The overall survival was better in patients who received HVP than that in patients who did not receive HVP (survival rate: 93.8% vs. 68.8% at 30 days) without overlap in survival curve between the two groups, although the difference between the two was statistically marginal (P=0.068). Among 18 patients with high SOFA score (≥13), the overall survival was significantly better for those who received HVP than those did not (90.9% vs. 28.6%, P=0.003). Conclusions: Initial clinical experience with HVP suggests that HVP can be a viable option to improve outcome for patients presenting with ALF, especially for those with high SOFA score.